CODE of COLORADO REGULATIONS 7 CCR 1101-3 Rule 18 - Exhibits 2 - 6 Division of Workers’ Compensation

DEPARTMENT OF LABOR AND EMPLOYMENT

Division of Workers’ Compensation

WORKERS’ COMPENSATION RULES OF PROCEDURE WITH TREATMENT GUIDELINES

MEDICAL FEE SCHEDULE - EXHIBITS 2 - 6

7 CCR 1101-3 Rule 18 - Exhibits 2 - 6 [Editor’s Notes follow the text of the rules at the end of this CCR Document.]

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Exhibit #2

Exhibit #2 Hospital Base Rates and Cost to Charge Ratios (CCR) For Hospital Inpatient Discharge Dates of Service on and after 1/1/2017 Provider Name Base Rate Total CCR Number 60001 NORTH COLORADO MEDICAL CENTER $6,784.96 0.254 60003 LONGMONT UNITED HOSPITAL $6,241.13 0.309 60004 PLATTE VALLEY MEDICAL CENTER $6,386.71 0.34 60006 MONTROSE MEMORIAL HOSPITAL $6,133.97 0.411 60008 SAN LUIS VALLEY HEALTH $6,242.35 0.373 60009 LUTHERAN MEDICAL CENTER $6,372.63 0.235 60010 POUDRE VALLEY HOSPITAL $6,539.44 0.304 60011 DENVER HEALTH MEDICAL CENTER $8,473.42 0.289 60012 CENTURA HEALTH-ST MARY CORWIN MEDICAL CENTER $6,675.37 0.249 60013 MERCY REGIONAL MEDICAL CENTER $7,906.12 0.34 60014 PRESBYTERIAN ST LUKES MEDICAL CENTER $7,007.25 0.184 60015 CENTURA HEALTH-ST ANTHONY HOSPITAL $6,331.38 0.201 60016 CENTURA HEALTH-ST THOMAS MORE HOSPITAL $6,915.90 0.4 60020 PARKVIEW MEDICAL CENTER INC $6,607.56 0.181 UNIVERSITY COLO HEALTH MEMORIAL HOSPITAL 60022 CENTRAL $6,417.21 0.256 60023 ST MARYS MEDICAL CENTER $6,886.88 0.303 60024 UNIVERSITY OF COLORADO HOSPITAL AUTHORITY $8,097.34 0.18 60027 FOOTHILLS HOSPITAL $6,180.76 0.23 60028 SAINT JOSEPH HOSPITAL $6,996.82 0.214 60030 MCKEE MEDICAL CENTER $6,418.54 0.37 CENTURA HEALTH-PENROSE ST FRANCIS HEALTH 60031 SERVICES $6,282.89 0.221 60032 ROSE MEDICAL CENTER $6,660.80 0.16 60034 SWEDISH MEDICAL CENTER $6,419.01 0.139

1 CODE OF COLORADO REGULATIONS 7 CCR 1101-3 Rule 18 - Exhibits 2 - 6 Division of Workers’ Compensation

Exhibit #2 Hospital Base Rates and Cost to Charge Ratios (CCR) For Hospital Inpatient Discharge Dates of Service on and after 1/1/2017 Provider Name Base Rate Total CCR Number 60036 ARKANSAS VALLEY REGIONAL MEDICAL CENTER $6,222.39 0.527 60043 KEEFE MEMORIAL HOSPITAL $15,890.85 0.483 60044 COLORADO PLAINS MEDICAL CENTER $6,519.64 0.276 60049 YAMPA VALLEY MEDICAL CENTER $9,549.81 0.549 60054 COMMUNITY HOSPITAL $5,990.97 0.393 60064 CENTURA HEALTH-PORTER ADVENTIST HOSPITAL $6,246.32 0.21 60065 NORTH SUBURBAN MEDICAL CENTER $6,590.82 0.143 60071 DELTA COUNTY MEMORIAL HOSPITAL $6,131.00 0.431 60075 VALLEY VIEW HOSPITAL ASSOCIATION $8,009.31 0.506 60076 STERLING REGIONAL MEDCENTER $7,753.03 0.524 60096 VAIL VALLEY MEDICAL CENTER $11,966.12 0.485 60100 MEDICAL CENTER OF AURORA, THE $6,383.70 0.161 60103 CENTURA HEALTH-AVISTA ADVENTIST HOSPITAL $6,399.01 0.281 60104 ST ANTHONY NORTH HEALTH CAMPUS $7,138.78 0.267 60107 NATIONAL JEWISH HEALTH $6,477.32 0.229 60112 SKY RIDGE MEDICAL CENTER $6,096.15 0.138 60113 CENTURA HEALTH-LITTLETON ADVENTIST HOSPITAL $6,093.76 0.186 60114 PARKER ADVENTIST HOSPITAL $6,212.10 0.209 60116 GOOD SAMARITAN MEDICAL CENTER $6,031.09 0.21 60117 ANIMAS SURGICAL HOSPITAL, LLC $5,909.40 0.395 60118 ST ANTHONY SUMMIT MEDICAL CENTER $6,280.79 0.356 60119 MEDICAL CENTER OF THE ROCKIES $6,173.86 0.299 ORTHOCOLORADO HOSPITAL AT ST ANTHONY MED 60124 CAMPUS $6,038.42 0.216 60125 CASTLE ROCK ADVENTIST HOSPITAL $6,095.85 0.297 60126 BANNER FORT COLLINS MEDICAL CENTER $6,056.28 0.251 69999 Any Hospital $6,056.28 0.251

2 CODE OF COLORADO REGULATIONS 7 CCR 1101-3 Rule 18 - Exhibits 2 - 6 Division of Workers’ Compensation

Exhibit #3

Exhibit #3 Critical Access Hospitals Hospital Name Location in Colorado Aspen Valley Hospital Aspen Colorado Canyon Hospital and Medical Center Fruita East Morgan County Hospital Brush Estes Park Medical Center Estes Park Grand River Hospital District Rifle Gunnison Valley Hospital Gunnison Haxtun Hospital District Haxtun Heart of the Rockies Regional Medical Center Salida Kit Carson County Memorial Hospital Burlington Lincoln Community Hospital Hugo Melissa Memorial Hospital Holyoke Middle Park Medical Center Kremmling/Granby Mt San Rafael Hospital Trinidad Pagosa Springs Medical Center Pagosa Springs Pikes Peak Regional Hospital Woodland Park Pioneers Medical Center Meeker Prowers Medical Center Lamar Rangely District Hospital Rangely Rio Grande Hospital Del Norte San Luis Valley Hospital La Jara Sedgwick County Health Center Julesburg Southeast Colorado Hospital Springfield Southwest Memorial Hospital Cortez Spanish Peaks Regional Health Center Walsenburg St Vincent General Hospital District Leadville The Memorial Hospital Craig Weisbrod Memorial County Hospital Eads Wray Community District Hospital Wray Yuma District Hospital Yuma

3 CODE OF COLORADO REGULATIONS 7 CCR 1101-3 Rule 18 - Exhibits 2 - 6 Division of Workers’ Compensation

Exhibit #4

Hospital ASC Payment APC APC Title Payment Rate Rate Notes Level 1 Examinations and Related 5011 Services $97.94 $0 Level 2 Examinations and Related 5012 Services $183.82 $0 Level 3 Examinations and Related 5013 Services $865.24 $0 5021 Level 1 Type A ED Visits $106.74 $0 5022 Level 2 Type A ED Visits $197.10 $0 5023 Level 3 Type A ED Visits $352.76 $0 5024 Level 4 Type A ED Visits $588.58 $0 5025 Level 5 Type A ED Visits $874.87 $0 5031 Level 1 Type B ED Visits $142.60 $0 5032 Level 2 Type B ED Visits $137.11 $0 5033 Level 3 Type B ED Visits $207.36 $0 5034 Level 4 Type B ED Visits $353.25 $0 5035 Level 5 Type B ED Visits $568.58 $0 5041 Critical Care $1,199.29 $0 See Trauma Activation fees under 5045 Trauma Response with Critical Care $0 $0 Rule 18-6(J)(6)(b)(v) 5051 Level 1 Skin Procedures $212.09 $180.28 5052 Level 2 Skin Procedures $405.99 $345.09 5053 Level 3 Skin Procedures $771.61 $655.87 5054 Level 4 Skin Procedures $2,540.18 $2,159.15 5055 Level 5 Skin Procedures $3,847.48 $3,270.36 5061 Hyperbaric Oxygen $193.88 $164.80 Level 1 Excision/ Biopsy/ Incision and 5071 Drainage $410.89 $349.25 Level 2 Excision/ Biopsy/ Incision and 5072 Drainage $865.15 $735.38 Level 3 Excision/ Biopsy/ Incision and 5073 Drainage $1,695.56 $1,441.23 Level 4 Excision/ Biopsy/ Incision and 5074 Drainage $2,545.70 $2,163.85 Level 1 Breast/Lymphatic Surgery and 5091 Related Procedures $3,938.29 $3,347.55 Level 2 Breast/Lymphatic Surgery and 5092 Related Procedures $6,564.71 $5,580.00 Level 3 Breast/Lymphatic Surgery and 5093 Related Procedures $13,603.95 $11,563.36 5101 Level 1 Strapping and Cast Application $214.63 $182.44

4 CODE OF COLORADO REGULATIONS 7 CCR 1101-3 Rule 18 - Exhibits 2 - 6 Division of Workers’ Compensation

Exhibit #4

Hospital ASC Payment APC APC Title Payment Rate Rate Notes 5102 Level 2 Strapping and Cast Application $374.18 $318.06 Level 1 Closed Treatment Fracture and 5111 Related Services $310.19 $263.66 Level 2 Closed Treatment Fracture and 5112 Related Services $427.50 $363.38 Level 3 Closed Treatment Fracture and 5113 Related Services $1,973.61 $1,677.57 5121 Level1 Musculoskeletal Procedures $2,619.47 $2,226.55 5122 Level 2 Musculoskeletal Procedures $4,312.06 $3,665.25 Applies to other "C" status indicator spine fusion operative procedures. Replaces the Division's previous 5123 Level 3 Musculoskeletal Procedures $8,944.67 $7,602.97 APC #210 5124 Level 4 Musculoskeletal Procedures $12,715.33 $10,808.03 Level 5 Musculoskeletal Procedures, 5125 including fusions $18,968.22 $16,122.99 5141 Thoracoscopy $5,675.26 $4,823.97 5151 Level 1 Airway Endoscopy $254.36 $216.20 5152 Level 2 Airway Endoscopy $675.23 $573.95 5153 Level 3 Airway Endoscopy $1,867.50 $1,587.38 5154 Level 4 Airway Endoscopy $3,585.46 $3,047.64 5155 Level 5 Airway Endoscopy $5,519.66 $4,691.71 5161 Level 1 ENT Procedures $232.72 $197.81 5162 Level 2 ENT Procedures $563.27 $478.78 5163 Level 3 ENT Procedures $1,241.33 $1,055.13 5164 Level 4 ENT Procedures $2,910.42 $2,473.86 5165 Level 5 ENT Procedures $7,120.76 $6,052.65 5166 Level 6 ENT Procedures $54,769.64 $46,554.20 5181 Level 1 Vascular Procedures $1,552.52 $1,319.64 5182 Level 2 Vascular Procedures $4,045.19 $3,438.41 5183 Level 3 Vascular Procedures $6,831.50 $5,806.78 5188 Diagnostic Cardiac Catheterization $4,588.42 $3,900.15 5191 Level 1 Endovascular Procedures $8,265.87 $7,025.99 5192 Level 2 Endovascular Procedures $17,176.23 $14,599.80 5193 Level 3 Endovascular Procedures $26,301.91 $22,356.62 5211 Level 1 Electrophysiologic Procedures $1,521.07 $1,292.91 5212 Level 2 Electrophysiologic Procedures $8,456.35 $7,187.89 5213 Level 3 Electrophysiologic Procedures $28,010.00 $23,808.50 Level1 Pacemaker and Similar 5221 Procedures $4,481.44 $3,809.23

5 CODE OF COLORADO REGULATIONS 7 CCR 1101-3 Rule 18 - Exhibits 2 - 6 Division of Workers’ Compensation

Exhibit #4

Hospital ASC Payment APC APC Title Payment Rate Rate Notes Level 2 Pacemaker and Similar 5222 Procedures $12,054.33 $10,246.18 Level 3 Pacemaker and Similar 5223 Procedures $16,692.12 $14,188.30 Level 4 Pacemaker and Similar 5224 Procedures $30,445.92 $25,879.03 5231 Level 1 ICD and Similar Procedures $39,474.05 $33,552.95 5232 Level 2 ICD and Similar Procedures $54,881.60 $46,649.36 5241 Transfusion $628.45 $534.18 Blood Product Exchange and Related 5271 Services $1,885.97 $1,603.07 Apheresis/Stem Cell and Related 5281 Services $5,427.11 $4,613.04 5291 Thrombolysis and Other Device Revisions $359.64 $305.69 5301 Level 1 Upper GI Procedures $1,341.65 $1,140.40 5302 Level 2 Upper GI Procedures $1,958.40 $1,664.64 5303 Level 3 Upper GI Procedures $3,564.77 $3,030.06 5311 Level 1 Lower GI Procedures $886.41 $753.45 5312 Level 2 Lower GI Procedures $1,354.97 $1,151.72 5313 Level 3 Lower GI Procedures $2,990.70 $2,542.10 5314 Level 4 Lower GI Procedures $4,187.95 $3,559.76 5331 Complex GI Procedures $6,504.43 $5,528.76 5341 Peritoneal and Abdominal Procedures $4,702.63 $3,997.23 Level 1 Percutaneous Abdominal/Biliary 5351 Procedures and Related Procedures $3,918.80 $3,330.98 Level 2 Percutaneous Abdominal/Biliary 5352 Procedures and Related Procedures $7,412.81 $6,300.89 5361 Level 1 Laparoscopy $7,202.07 $6,121.76 5362 Level 2 Laparoscopy $12,349.64 $10,497.19 5371 Level 1 Urology and Related Services $371.90 $316.11 5372 Level 2 Urology and Related Services $944.06 $802.45 5373 Level 3 Urology and Related Services $2,711.56 $2,304.82 5374 Level 4 Urology and Related Services $4,038.28 $3,432.54 5375 Level 5 Urology and Related Services $6,108.71 $5,192.41 5376 Level 6 Urology and Related Services $13,370.89 $11,365.25 5377 Level 7 Urology and Related Services $25,358.44 $21,554.67 Level 1 Tube/Catheter 5391 Changes/Thoracentesis/Lavage $869.09 $738.73 Level 2 Tube/Catheter 5392 Changes/Thoracentesis/Lavage $2,173.95 $1,847.86 5401 Dialysis $984.01 $836.41 5411 Level 1 Gynecologic Procedures $253.06 $215.10 5412 Level 2 Gynecologic Procedures $451.62 $383.88

6 CODE OF COLORADO REGULATIONS 7 CCR 1101-3 Rule 18 - Exhibits 2 - 6 Division of Workers’ Compensation

Exhibit #4

Hospital ASC Payment APC APC Title Payment Rate Rate Notes 5413 Level 3 Gynecologic Procedures $1,146.31 $974.37 5414 Level 4 Gynecologic Procedures $3,350.12 $2,847.61 5415 Level 5 Gynecologic Procedures $6,588.36 $5,600.11 5416 Level 6 Gynecologic Procedures $10,258.11 $8,719.39 5431 Level 1 Nerve Procedures $2,506.61 $2,130.62 5432 Level 2 Nerve Procedures $6,114.20 $5,197.07 5441 Level 1 Nerve Injections $402.77 $342.35 5442 Level 2 Nerve Injections $1,053.31 $895.31 5443 Level 3 Nerve Injections $1,479.78 $1,257.81 Level 1 Neurostimulator and Related 5461 Procedures $3,939.55 $3,348.62 Level 2 Neurostimulator and Related 5462 Procedures $9,439.87 $8,023.89 Level 3 Neurostimulator and Related 5463 Procedures $31,246.87 $26,559.84 Level 4 Neurostimulator and Related 5464 Procedures $48,111.10 $40,894.44 5471 Implantation of Drug Infusion Device $27,630.40 $23,485.84 5481 Laser Eye Procedures $792.68 $673.78 5491 Level 1 Intraocular Procedures $3,142.26 $2,670.92 5492 Level 2 Intraocular Procedures $6,085.39 $5,172.58 5493 Level 3 Intraocular Procedures $16,917.16 $14,379.58 5494 Level 4 Intraocular Procedures $31,591.49 $26,852.77 Level 1 Extraocular, Repair, and Plastic 5501 Eye Procedures $469.85 $399.38 Level 2 Extraocular, Repair, and Plastic 5502 Eye Procedures $1,254.08 $1,065.97 Level 3 Extraocular, Repair, and Plastic 5503 Eye Procedures $2,522.09 $2,143.77 Level 4 Extraocular, Repair, and Plastic 5504 Eye Procedures $4,518.63 $3,840.84 5521 Level 1 X-Ray and Related Services $109.44 $93.02 5522 Level 2 X-Ray and Related Services $181.24 $154.06 5523 Level 3 X-Ray and Related Services $345.55 $293.71 5524 Level 4 X-Ray and Related Services $633.08 $538.12 5525 Level 5 X-Ray and Related Services $1,202.27 $1,021.93 5526 Level 6 X-Ray and Related Services $4,893.89 $4,159.81 5531 Level 1 Ultrasound and Related Services $165.73 $140.87 5532 Level 2 Ultrasound and Related Services $276.44 $234.98 5533 Level 3 Ultrasound and Related Services $750.24 $637.70 5534 Level 4 Ultrasound and Related Services $1,257.57 $1,068.93 5561 Level 1 Echocardiogram with Contrast $817.29 $694.70

7 CODE OF COLORADO REGULATIONS 7 CCR 1101-3 Rule 18 - Exhibits 2 - 6 Division of Workers’ Compensation

Exhibit #4

Hospital ASC Payment APC APC Title Payment Rate Rate Notes 5562 Level 2 Echocardiogram with Contrast $1,207.73 $1,026.57 5570 Computed Tomography without Contrast $202.48 $172.11 Level 1 Computed Tomography with Contrast and Computed Tomography 5571 Angiography $426.35 $362.40 Level 2 Computed Tomography with Contrast and Computed Tomography 5572 Angiography $625.90 $532.01 Magnetic Resonance Imaging and Magnetic Resonance Angiography without 5581 Contrast $492.37 $418.52 Magnetic Resonance Imaging and Magnetic Resonance Angiography with 5582 Contrast $817.78 $695.11 Level 1 Nuclear Medicine and Related 5591 Services $598.77 $508.95 Level 2 Nuclear Medicine and Related 5592 Services $794.45 $675.28 Level 3 Nuclear Medicine and Related 5593 Services $1,995.23 $1,695.94 Level 4 Nuclear Medicine and Related 5594 Services $2,313.31 $1,966.31 Level 1 Therapeutic Radiation Treatment 5611 Preparation $193.32 $164.32 Level 2 Therapeutic Radiation Treatment 5612 Preparation $299.97 $254.97 Level 3 Therapeutic Radiation Treatment 5613 Preparation $525.19 $446.41 Level 4 Therapeutic Radiation Treatment 5614 Preparation $1,848.26 $1,571.02 5621 Level 1 Radiation Therapy $198.61 $168.82 5622 Level 2 Radiation Therapy $349.83 $297.36 5623 Level 3 Radiation Therapy $909.92 $773.43 5624 Level 4 Radiation Therapy $1,253.18 $1,065.20 5625 Level 5 Radiation Therapy $2,071.24 $1,760.56 5626 Level 6 Radiation Therapy $3,009.44 $2,558.02 5627 Level 7 Radiation Therapy $13,140.43 $11,169.37 5661 Therapeutic Nuclear Medicine $449.96 $382.47 5671 Level 1 Pathology $85.95 $73.06 5672 Level 2 Pathology $183.96 $156.37 5673 Level 3 Pathology $376.96 $320.41 5674 Level 4 Pathology $792.95 $674.01 5681 Transfusion Laboratory Procedures $185.44 $157.62 5691 Level 1 Drug Administration $55.57 $47.23 5692 Level 2 Drug Administration $76.16 $64.73

8 CODE OF COLORADO REGULATIONS 7 CCR 1101-3 Rule 18 - Exhibits 2 - 6 Division of Workers’ Compensation

Exhibit #4

Hospital ASC Payment APC APC Title Payment Rate Rate Notes 5693 Level 3 Drug Administration $166.32 $141.37 5694 Level 4 Drug Administration $311.72 $264.97 5695 Level 5 Drug Administration $504.49 $428.81 5701 Dosimetric Drug Administration $3,548.90 $3,016.56 Level1 Diagnostic Tests and Related 5721 Services $233.55 $198.52 Level 2 Diagnostic Tests and Related 5722 Services $396.63 $337.14 Level 3 Diagnostic Tests and Related 5723 Services $713.74 $606.68 Level 4 Diagnostic Tests and Related 5724 Services $1,541.59 $1,310.35 5731 Level 1 Minor Procedures $22.86 $19.43 5732 Level 2 Minor Procedures $54.92 $46.68 5733 Level 3 Minor Procedures $100.69 $85.59 5734 Level 4 Minor Procedures $164.12 $139.51 5741 Level 1 Electronic Analysis of Devices $60.52 $51.44 5742 Level 2 Electronic Analysis of Devices $191.59 $162.85 5743 Level 3 Electronic Analysis of Devices $434.12 $369.01 5771 Cardiac Rehabilitation $187.06 $159.00 5781 Resuscitation and Cardioversion $840.76 $714.65 5791 Pulmonary Treatment $269.03 $228.67 5801 Ventilation Initiation and Management $822.80 $699.38 5811 Manipulation Therapy $41.31 $35.11 5821 Level 1 Health and Behavior Services $48.82 $41.49 5822 Level 2 Health and Behavior Services $125.37 $106.56 5841 Psychotherapy $225.07 $191.31 5871 Dental Procedures $668.18 $567.95 Ancillary Outpatient Services When 5881 Patient Dies $11,058.75 $9,399.94 8001 LDR Prostate Brachytherapy Composite $6,093.79 $5,179.72 8004 Ultrasound Composite $517.07 $439.51 8005 CT and CTA without Contrast Composite $511.42 $434.70 8006 CT and CTA with Contrast Composite $889.04 $755.68 MRI and MRA without Contrast 8007 Composite $1,018.91 $866.07 8008 MRI and MRA with Contrast Composite $1,552.03 $1,319.23 8011 Comprehensive Observation Services $3,913.45 $3,326.43

9 CODE OF COLORADO REGULATIONS 7 CCR 1101-3 Rule 18 - Exhibits 2 - 6 Division of Workers’ Compensation

Exhibit #5

Exhibit #5 Rural Health Clinics

AKRON CLINIC 82 MAIN AKRON, CO 80720 - WASHINGTON COUNTY Telephone: (970)345-6336, Fax: (970)345-6576

ARKANSAS VALLEY FAMILY PRACTICE, LLC 2317 SAN JUAN AVE LA JUNTA, CO 81050 - OTERO COUNTY Telephone: (719)383-2325, Fax: (719)383-2327

BASIN CLINIC 421 WEST ADAMS ROAD NATURITA, CO 81422 - MONTROSE COUNTY Telephone: (970)865-2665, Fax: (970)825-2674

BRUSH FAMILY CLINIC 2400 W EDISON BRUSH, CO 80723 - MORGAN COUNTY Telephone: (970)842-6740, Fax: (970)842-6241

BUENA VISTA HEALTH CENTER 28374 COUNTY ROAD 317 BUENA VISTA, CO 81211 - CHAFFEE COUNTY Telephone: (719)395-9048, Fax: (719)395-9064

BUTTON FAMILY PRACTICE 715 SOUTH 9TH STREET CANON CITY, CO 81212 - FREMONT COUNTY Telephone: (719)269-8820, Fax: (719)204-0230

CENTENNIAL FAMILY HEALTH CENTER 319 MAIN STREET ORDWAY, CO 81063 - CROWLEY COUNTY Telephone: (719)267-3503, Fax: (719)267-4153

10 CODE OF COLORADO REGULATIONS 7 CCR 1101-3 Rule 18 - Exhibits 2 - 6 Division of Workers’ Compensation

Exhibit #5 Rural Health Clinics

CORTEZ PRIMARY CARE CLINIC 118 NORTH CHESTNUT CORTEZ, CO 81321 - MONTEZUMA COUNTY Telephone: (970)564-9777, Fax: (970)564-8833

CREEDE FAMILY PRACTICE OF RIO GRANDE HOSPITAL 802 RIO GRANDE AVENUE CREEDE, CO 81130 - MINERAL COUNTY Telephone: (719)658-0929, Fax: (719)657-2851

CUSTER COUNTY MEDICAL CENTER 704 EDWARDS WESTCLIFFE, CO 81252 - CUSTER COUNTY Telephone: (719)783-2380, Fax: (719)783-2377

DOLORES MEDICAL CENTER 507 CENTRAL AVENUE DOLORES, CO 81323 - MONTEZUMA COUNTY Telephone: (970)882-7221, Fax: (970)882-4243

EADS MEDICAL CLINIC 1211 LUTHER STREET EADS, CO 81036 - KIOWA COUNTY Telephone: (719)438-2251, Fax: (719)438-2254

EASTERN PLAINS MEDICAL CLINIC OF CALHAN 560 CRYSTOLA STREET CALHAN, CO 80808 - EL PASO COUNTY Telephone: (719)347-0100, Fax: (719)347-0551

FAMILY CARE CLINIC 615 FAIRHURST STERLING, CO 80751 - LOGAN COUNTY Telephone: (970)521-3223, Fax: (970)521-3266

FAMILY PRACTICE OF HOLYOKE 1001 EAST JOHNSON STREET HOLYOKE, CO 80734 - PHILLIPS COUNTY Telephone: (970)854-2500, Fax: (970)854-3440

11 CODE OF COLORADO REGULATIONS 7 CCR 1101-3 Rule 18 - Exhibits 2 - 6 Division of Workers’ Compensation

Exhibit #5 Rural Health Clinics

FLORENCE MEDICAL CENTER 501 W 5TH ST FLORENCE, CO 81226 - FREMONT COUNTY Telephone: (719)784-4816, Fax: (719)784-6014 FORT MORGAN PEDIATRIC CLINIC, PC 1000 LINCOLN STREET, STE 202 FORT MORGAN, CO 80701 - MORGAN COUNTY Telephone: (970)542-9187, Fax: (970)867-9187

GRAND RIVER HEALTH CLINIC WEST 201 SIPPERELLE DRIVE PARACHUTE, CO 81635 - GARFIELD COUNTY Telephone: (970)285-7046, Fax: (970)285-6064

GRAND RIVER PRIMARY CARE 501 AIRPORT ROAD RIFLE, CO 81650 - GARFIELD COUNTY Telephone: (970)625-1100, Fax: (970)625-0725

KIT CARSON CLINIC 102 EAST 2ND AVENUE KIT CARSON, CO 80825 - CHEYENNE COUNTY Telephone: (719)962-3501, Fax: (719)962-3403

LAKE CITY AREA MEDICAL CENTER 700 N HENSON STREET LAKE CITY, CO 81235 - HINSDALE COUNTY Telephone: (970)944-2331, Fax: (970)944-2320

LAMAR MEDICAL CLINIC 403 KENDALL DRIVE LAMAR, CO 81052 - PROWERS COUNTY Telephone: (719)336-6767, Fax: (719)336-7217

MANCOS VALLEY HEALTH CENTER 111 RAILROAD AVE MANCOS, CO 81328 - MONTEZUMA COUNTY Telephone: (970)564-2104, Fax: (970)564-2134

12 CODE OF COLORADO REGULATIONS 7 CCR 1101-3 Rule 18 - Exhibits 2 - 6 Division of Workers’ Compensation

Exhibit #5 Rural Health Clinics

MEEKER FAMILY HEALTH CENTER 345 CLEVELAND STREET MEEKER, CO 81641 - RIO BLANCO COUNTY Telephone: (970)878-4014, Fax: (970)878-3285

MT SAN RAFAEL HOSPITAL HEALTH CLINIC 400 BENEDICTA STE A TRINIDAD, CO 81082 - LAS ANIMAS COUNTY Telephone: (719)846-2206, Fax: (719)846-7823

NORTH PARK MEDICAL CENTER - WALDEN 350 MCKINLEY STREET WALDEN, CO 80480 - JACKSON COUNTY Telephone: (970)723-4255, Fax: (970)723-4268

PAGOSA MOUNTAIN CLINIC 95 SOUTH PAGOSA BLVD PAGOSA SPRINGS, CO 81147 - ARCHULETA COUNTY Telephone: (970)731-3700, Fax: (970)731-3707

PARKE HEALTH CLINIC 182 16TH ST BURLINGTON, CO 80807 - KIT CARSON COUNTY Telephone: (719)346-9481, Fax: (719)346-9485

PEDIATRIC ASSOCIATION OF CANON CITY 1335 PHAY AVENUE, SUITE A CANON CITY, CO 81212 - FREMONT COUNTY Telephone: (719)269-1727, Fax: (719)269-1730

PRAIRIE VIEW RURAL HEALTH CLINIC 615 WEST 5TH NORTH CHEYENNE WELLS, CO 80810 - CHEYENNE COUNTY Telephone: (719)767-5669, Fax: (719)767-5098

RIO GRANDE HOSPITAL CLINIC 0310C COUNTY RD 14 DEL NORTE, CO 81132 - RIO GRANDE COUNTY Telephone: (719)657-2418, Fax: (719)658-3001

13 CODE OF COLORADO REGULATIONS 7 CCR 1101-3 Rule 18 - Exhibits 2 - 6 Division of Workers’ Compensation

Exhibit #5 Rural Health Clinics

ROCKY FORD FAMILY HEALTH CENTER 1014 ELM AVENUE ROCKY FORD, CO 81067 - OTERO COUNTY Telephone: (719)254-7421, Fax: (719)254-6966

SABATINI PEDIATRICS PC 612 YALE PLACE CANON CITY, CO 81212 - FREMONT COUNTY Telephone: (719)275-3442, Fax: (719)275-2306

SAN LUIS VALLEY HEALTH ANTONITO CLINIC 115 MAIN STREET ANTONITO, CO 81120 - CONEJOS COUNTY Telephone: (719)376-2308, Fax: (719)376-2395

SAN LUIS VALLEY LA JARA MEDICAL CLINIC 509 MAIN STREET LA JARA, CO 81140 - CONEJOS COUNTY Telephone: (719)274-5000, Fax: (719)274-4111

SOUTHEAST COLORADO PHYSICIANS CLINIC 900 CHURCH STREET SPRINGFIELD, CO 81073 - BACA COUNTY Telephone: (719)523-6628, Fax: (719)523-4513

SOUTHWEST MEMORIAL PRIMARY CARE 33 NORTH ELM STREET CORTEZ, CO 81321 - MONTEZUMA COUNTY Telephone: (970)565-8556, Fax: (970)564-1134

SOUTHWEST WALK-IN CARE 2095 NORTH DOLORES ROAD, STE C CORTEZ, CO 81321 - MONTEZUMA COUNTY Telephone: (970)564-1037, Fax: (970)564-1041

SPANISH PEAKS FAMILY CLINIC 23400 US HIGHWAY 160 WALSENBURG, CO 81089 - HUERFANO COUNTY Telephone: (719)738-4591, Fax: (719)738-4553

14 CODE OF COLORADO REGULATIONS 7 CCR 1101-3 Rule 18 - Exhibits 2 - 6 Division of Workers’ Compensation

Exhibit #5 Rural Health Clinics

STRATTON MEDICAL CLINIC 500 NEBRASKA AVENUE STRATTON, CO 80836 - KIT CARSON COUNTY Telephone: (719)348-4650, Fax: (719)348-4653

SURFACE CREEK FAMILY PRACTICE 255 SW 8TH AVE CEDAREDGE, CO 81413 - DELTA COUNTY Telephone: (970)856-3146, Fax: (970)856-4385

VALLEY MEDICAL CLINIC 116 E NINTH STREET JULESBURG, CO 80737 - SEDGWICK COUNTY Telephone: (970)474-3376, Fax: (970)474-2461

WALSH MEDICAL CLINIC 137 KANSAS STREET WALSH, CO 81090 - BACA COUNTY Telephone: (719)324-5253, Fax: (719)324-5621

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15 CODE OF COLORADO REGULATIONS 7 CCR 1101-3 Rule 18 - Exhibits 2 - 6 Division of Workers’ Compensation

Exhibit #6

Dental Fee Schedule

CDT 2017 Fees CDT 2017 Fees CDT 2017 Fees 2016 2016 2016 D0120 $67.15 D0366 $1,251.00 D0477 $232.00 D0140 $112.29 D0367 $1,251.00 D0478 $212.00 D0145 $104.19 D0368 $1,831.00 D0479 $325.00 D0150 $118.08 D0369 $3,274.00 D0480 $200.00 D0160 $237.31 D0370 $1,102.00 D0481 $858.14 D0170 $78.72 D0371 BR D0482 $250.00 D0171 $71.25 D0380 $998.00 D0483 $250.00 D0180 $128.50 D0381 $998.00 D0484 $375.00 D0190 $62.00 D0382 $998.00 D0485 $517.00 D0191 $44.00 D0383 $998.00 D0486 $240.00 D0210 $187.18 D0384 $1,459.00 D0502 BR D0220 $37.68 D0385 $2,382.00 D0601 $93.00 D0230 $34.03 D0386 $596.00 D0602 $93.00 D0240 $58.35 D0391 BR D0603 $93.00 D0250 $71.72 D0393 BR D0999 BR D0251 BR D0394 BR D1110 $120.33 D0270 $38.89 D0395 BR D1120 $83.87 D0272 $63.21 D0415 $72.00 D1206 $72.93 D0273 $76.58 D0416 $106.00 D1208 $45.15 D0274 $88.74 D0417 $97.00 D1310 $70.61 D0277 $133.71 D0418 $100.00 D1320 $77.56 D0290 $218.79 D0422 BR D1330 $97.24 D0310 $556.70 D0423 BR D1351 $78.72 D0320 $948.10 D0425 $62.00 D1352 $94.50 D0321 BR D0431 $100.00 D1353 $80.75 D0322 $765.77 D0460 $100.00 D1354 BR D0330 $165.54 D0470 $219.00 D1510 $503.57 D0340 $186.38 D0472 $137.00 D1515 $704.99 D0350 $89.13 D0473 $290.00 D1520 $554.51 D0351 $73.75 D0474 $325.00 D1525 $856.64 D0364 $1,251.00 D0475 $175.00 D1550 $108.82 D0365 $1,251.00 D0476 $170.00 D1555 $104.19

16 CODE OF COLORADO REGULATIONS 7 CCR 1101-3 Rule 18 - Exhibits 2 - 6 Division of Workers’ Compensation

CDT 2017 Fees CDT 2017 Fees CDT 2017 Fees 2016 2016 2016 D1999 BR D2712 $628.41 D2957 $238.23 D2140 $262.55 D2720 $1,548.55 D2960 $1,152.30 D2150 $339.13 D2721 $1,451.31 D2961 $1,306.67 D2160 $410.84 D2722 $1,482.92 D2962 $1,419.72 D2161 $500.79 D2740 $1,588.67 D2971 $228.51 D2330 $239.45 D2750 $1,568.01 D2975 $695.27 D2331 $306.31 D2751 $1,459.83 D2980 BR D2332 $374.38 D2752 $1,495.07 D2981 BR D2335 $443.66 D2780 $1,503.58 D2982 BR D2390 $491.06 D2781 $1,414.85 D2983 BR D2391 $280.78 D2782 $1,461.04 D2990 $94.00 D2392 $368.30 D2783 $1,546.13 D2999 BR D2393 $457.03 D2790 $1,512.09 D3110 $131.25 D2394 $560.35 D2791 $1,433.08 D3120 $105.35 D2410 $457.26 D2792 $1,459.83 D3220 $268.80 D2420 $762.88 D2794 $1,548.55 D3221 $295.20 D2430 $1,322.01 D2799 $628.41 D3222 $273.20 D2510 $1,209.72 D2910 $143.43 D3230 $307.52 D2520 $1,372.95 D2915 $143.43 D3240 $379.24 D2530 $1,582.48 D2920 $144.65 D3310 $1,207.00 D2542 $1,551.22 D2921 $179.50 D3320 $1,479.27 D2543 $1,623.00 D2929 $543.00 D3330 $1,834.20 D2544 $1,687.82 D2930 $395.04 D3331 $472.84 D2610 $1,423.88 D2931 $447.31 D3332 $899.47 D2620 $1,502.60 D2932 $476.48 D3333 $414.49 D2630 $1,601.00 D2933 $545.76 D3346 $1,609.34 D2642 $1,555.85 D2934 $545.76 D3347 $1,893.76 D2643 $1,677.40 D2940 $150.73 D3348 $2,343.50 D2644 $1,779.27 D2941 $130.00 D3351 $968.76 D2650 $935.36 D2949 $130.00 D3352 $433.93 D2651 $1,114.80 D2950 $376.80 D3353 $1,335.84 D2652 $1,171.52 D2951 $85.08 D3355 $577.25 D2662 $1,016.40 D2952 $595.60 D3356 $259.00 D2663 $1,195.82 D2953 $297.80 D3357 BR D2664 $1,281.49 D2954 $476.48 D3410 $1,920.50 D2710 $628.41 D2955 $367.08 D3421 $2,138.07

17 CODE OF COLORADO REGULATIONS 7 CCR 1101-3 Rule 18 - Exhibits 2 - 6 Division of Workers’ Compensation

CDT 2017 Fees CDT 2017 Fees CDT 2017 Fees 2016 2016 2016 D3425 $2,421.29 D4276 $3,294.00 D5610 $278.00 D3426 $818.03 D4277 $2,493.00 D5620 $316.03 D3427 $1035.75 D4278 $819.00 D5630 $363.00 D3428 $1509.25 D4283 BR D5640 $235.00 D3429 $1439.50 D4285 BR D5650 $321.00 D3430 $601.67 D4320 $625.99 D5660 $385.00 D3431 $1772.25 D4321 $633.28 D5670 $1,006.44 D3432 $1523.50 D4341 $361.00 D5671 $1,006.44 D3450 $1,251.97 D4342 $217.57 D5710 $951.00 D3460 $4,676.05 D4355 $246.75 D5711 $909.00 D3470 $2,388.47 D4381 BR D5720 $898.00 D3910 $334.27 D4910 $222.44 D5721 $898.00 D3920 $951.74 D4920 $161.66 D5730 $537.00 D3950 $433.93 D4921 BR D5731 $537.00 D3999 BR D4999 BR D5740 $492.00 D4210 $1,603.00 D5110 $2,343.00 D5741 $492.00 D4211 $712.00 D5120 $2,343.00 D5750 $716.00 D4212 $570.00 D5130 $2,555.00 D5751 $716.00 D4230 $2,244.00 D5140 $2,555.00 D5760 $705.00 D4231 $1,096.39 D5211 $1,977.00 D5761 $705.00 D4240 $2,030.00 D5212 $2,298.00 D5810 $1,133.00 D4241 $1,175.00 D5213 $2,771.36 D5811 $1,218.00 D4245 $1,496.00 D5214 $2,589.00 D5820 $876.00 D4249 $2,226.00 D5221 BR D5821 $930.00 D4260 $3,383.00 D5222 BR D5850 $224.00 D4261 $1,816.00 D5223 BR D5851 $224.00 D4263 $1,211.00 D5224 BR D5862 BR D4264 $1,033.00 D5225 $1,977.00 D5863 $2,295.25 D4265 BR D5226 $2,298.00 D5864 BR D4266 $1,247.00 D5281 $1,509.00 D5865 $2,295.25 D4267 $1,603.00 D5410 $128.00 D5866 $3,146.00 D4268 BR D5411 $128.00 D5867 BR D4270 $2,404.00 D5421 $128.00 D5875 BR D4273 $2,938.00 D5422 $128.00 D5899 BR D4274 $1,667.00 D5510 $274.70 D5911 $594.00 D4275 $2,208.00 D5520 $214.00 D5912 $594.00

18 CODE OF COLORADO REGULATIONS 7 CCR 1101-3 Rule 18 - Exhibits 2 - 6 Division of Workers’ Compensation

CDT 2017 Fees CDT 2017 Fees CDT 2017 Fees 2016 2016 2016 D5913 $12,514.00 D5992 BR D6090 BR D5914 $12,514.00 D5993 BR D6091 $887.00 D5915 $16,935.00 D5994 $227.50 D6092 $173.00 D5916 $4,517.00 D5999 BR D6093 $271.00 D5919 BR D6010 $3,914.00 D6094 $1,887.68 D5922 BR D6011 BR D6095 BR D5923 BR D6012 $3,698.00 D6100 BR D5924 BR D6013 $3,623.00 D6101 $587.50 D5925 BR D6040 $14,418.34 D6102 $769.75 D5926 BR D6050 $10,047.00 D6103 $672.50 D5927 BR D6051 BR D6104 $672.50 D5928 BR D6052 $1,535.25 D6110 $2,705.00 D5929 BR D6055 $1,176.00 D6111 $2,705.00 D5931 $6,738.00 D6056 $812.00 D6112 $2,705.00 D5932 $12,602.00 D6057 $1,005.00 D6113 $2,705.00 D5933 BR D6058 $2,253.00 D6114 BR D5934 $11,486.00 D6059 $2,379.96 D6115 BR D5935 $9,994.00 D6060 $2,249.90 D6116 BR D5936 $11,225.00 D6061 $2,294.88 D6117 BR D5937 $1,411.50 D6062 $2,286.36 D6190 $395.00 D5951 $1,834.00 D6063 $1,963.04 D6194 $1,817.00 D5952 $5,956.00 D6064 $2,079.74 D6199 BR D5953 $11,310.00 D6065 $2,217.00 D6205 $1,016.16 D5954 $10,481.00 D6066 $2,311.89 D6210 $1,553.41 D5955 $9,694.00 D6067 $2,242.61 D6211 $1,454.96 D5958 BR D6068 $2,234.00 D6212 $1,514.52 D5959 BR D6069 $2,379.96 D6214 $1,563.15 D5960 BR D6070 $2,249.90 D6240 $1,533.97 D5982 $997.93 D6071 $2,144.00 D6241 $1,416.06 D5983 $2,416.43 D6072 $2,343.50 D6242 $1,493.86 D5984 $2,416.43 D6073 $2,121.06 D6245 $1,582.59 D5985 $2,416.43 D6074 $2,106.00 D6250 $1,514.52 D5986 $241.00 D6075 $2,217.00 D6251 $1,396.62 D5987 $3,627.07 D6076 $2,311.89 D6252 $1,441.59 D5988 $641.00 D6077 $2,242.61 D6253 $652.72 D5991 $246.00 D6080 $184.00 D6545 $610.19

19 CODE OF COLORADO REGULATIONS 7 CCR 1101-3 Rule 18 - Exhibits 2 - 6 Division of Workers’ Compensation

CDT 2017 Fees CDT 2017 Fees CDT 2017 Fees 2016 2016 2016 D6548 $651.00 D6794 $1,571.65 D7320 $1,640.00 D6549 $377.21 D6920 $420.57 D7321 $1,388.00 D6600 $1,186.33 D6930 $245.53 D7340 $6,938.00 D6601 $1,266.56 D6940 $556.70 D7350 $20,182.00 D6602 $1,294.51 D6950 $1,074.51 D7410 $3,027.00 D6603 $1,424.58 D6980 BR D7411 $4, 793.00 D6604 $1,268.99 D6985 $934.72 D7412 $5,298.00 D6605 $1,344.35 D6999 BR D7413 $3,532.00 D6606 $1,248.32 D7111 $229.73 D7414 $5,298.00 D6607 $1,385.67 D7140 $305.09 D7415 $5,928.00 D6608 $1,277.00 D7210 $405.98 D7440 $4,793.00 D6609 $1,355.29 D7220 $509.29 D7441 $7,064.00 D6610 $1,396.62 D7230 $678.25 D7450 $3,027.00 D6611 $1,527.89 D7240 $796.15 D7451 $4,137.00 D6612 $1,389.33 D7241 $1,000.37 D7460 $3,027.00 D6613 $1,452.53 D7250 $429.07 D7461 $4,137.00 D6614 $1,358.93 D7251 $770.70 D7465 $1,640.00 D6615 $1,413.64 D7260 $3,182.19 D7471 $3,749.00 D6624 $1,294.51 D7261 $1,104.60 D7472 $4,455.00 D6634 $1,358.93 D7270 $828.45 D7473 $4,203.00 D6710 $1,345.00 D7272 $1,104.60 D7485 $3,749.00 D6720 $1,619.06 D7280 $772.80 D7490 $30,273.00 D6721 $1,535.18 D7282 $386.40 D7510 $1,085.00 D6722 $1,563.15 D7283 $331.80 D7511 $1,640.00 D6740 $1,650.00 D7285 $1,546.65 D7520 $5,167.00 D6750 $1,656.73 D7286 $662.55 D7521 $5,676.00 D6751 $1,546.13 D7287 $265.65 D7530 $1,862.00 D6752 $1,583.81 D7288 $265.65 D7540 $2,064.00 D6780 $1,563.15 D7290 $662.55 D7550 $1,287.00 D6781 $1,516.00 D7291 $446.76 D7560 $10,217.00 D6782 $1,563.15 D7292 $1,060.50 D7610 $16,524.00 D6783 $1,561.00 D7293 $662.55 D7620 $12,392.00 D6790 $1,599.60 D7294 $552.30 D7630 $21,484.00 D6791 $1,516.96 D7295 BR D7640 $13,633.00 D6792 $1,571.65 D7310 $1,009.00 D7650 $10,328.00 D6793 $637.00 D7311 $883.00 D7660 $6,090.00

20 CODE OF COLORADO REGULATIONS 7 CCR 1101-3 Rule 18 - Exhibits 2 - 6 Division of Workers’ Compensation

CDT 2017 Fees CDT 2017 Fees CDT 2017 Fees 2016 2016 2016 D7670 $4,753.00 D7912 $7,437.00 D8040 BR D7671 $8,956.00 D7920 $12,185.00 D8050 BR D7680 $30,984.00 D7921 $1,125.00 D8060 BR D7710 $19,420.00 D7940 BR D8070 BR D7720 $13,633.00 D7941 $31,030.00 D8080 BR D7730 $28,093.00 D7943 $28,507.00 D8090 BR D7740 $13,900.00 D7944 $25,404.00 D8210 BR D7750 $17,679.00 D7945 $33,805.00 D8220 BR D7760 $7,094.00 D7946 $41,878.00 D8660 $700.13 D7770 $9,612.00 D7947 $35,218.00 D8670 $525.09 D7771 $7,417.00 D7948 $45,712.00 D8680 $1,154.73 D7780 $41,313.00 D7949 $59,537.00 D8681 BR D7810 $18,174.00 D7950 BR D8690 $545.76 D7820 $2,977.00 D7951 BR D8691 $512.95 D7830 $1,705.00 D7952 BR D8692 $571.28 D7840 $24,773.00 D7953 $858.00 D8693 $528.75 D7850 $21,393.00 D7955 BR D8694 BR D7852 $24,496.00 D7960 $1,388.00 D8999 BR D7854 $25,278.00 D7963 $2,270.00 D9110 $215.15 D7856 $17,937.00 D7970 $2,018.00 D9120 $243.11 D7858 $51,126.00 D7971 $757.00 D9210 $181.65 D7860 $21,792.00 D7972 $2,825.00 D9211 $200.55 D7865 $35,117.00 D7980 $3,179.00 D9212 $312.90 D7870 $1,160.00 D7981 BR D9215 $150.15 D7871 $2,321.00 D7982 $7,518.00 D9219 BR D7872 $12,387.00 D7983 $7,215.00 D9223 BR D7873 $14,914.00 D7990 $6,206.00 D9243 BR D7874 $21,393.00 D7991 $5,137.00 D9248 $437.85 D7875 $23,436.00 D7995 BR D9310 $487.42 D7876 $25,268.00 D7996 BR D9410 $557.92 D7877 $22,301.00 D7997 $1,160.00 D9420 $903.13 D7880 $2,785.00 D7998 $5,046.00 D9430 $151.94 D7881 BR D7999 BR D9440 $305.09 D7899 BR D8010 BR D9450 $151.94 D7910 $1,655.00 D8020 BR D9610 BR D7911 $4,132.00 D8030 BR D9612 BR

21 CODE OF COLORADO REGULATIONS 7 CCR 1101-3 Rule 18 - Exhibits 2 - 6 Division of Workers’ Compensation

CDT 2017 Fees CDT 2017 Fees CDT 2017 Fees 2016 2016 2016 D9630 BR D9940 $940.80 D9972 $590.39 D9910 $103.03 D9941 $307.52 D9973 $97.24 D9911 $144.70 D9942 $354.24 D9974 $516.31 D9920 BR D9943 BR D9975 $576.00 D9930 BR D9950 $560.29 D9985 BR D9932 BR D9951 $251.20 D9986 BR D9933 BR D9952 $1,179.62 D9987 BR D9934 BR D9970 $133.13 D9999 BR D9935 BR D9971 $171.33

______

Editor’s Notes

7 CCR 1101-3 has been divided into smaller sections for ease of use. Versions prior to 01/01/2011 and rule history are located in the first section, 7 CCR 1101-3. Prior versions can be accessed from the All Versions list on the rule’s current version page. To view versions effective on or after 01/01/2011, select the desired part of the rule, for example 7 CCR 1101-3 Rules 1-17, or 7 CCR 1101-3 Rule 18: Exhibit 1.

History [For history of this section, see Editor’s Notes in the first section, 7 CCR 1101-3]